Specific Aims: (Study #1, funded by AHRQ, completed May 2011)

1. To create an automatic notification system to prompt physicians of test results finalized after discharge.
2. To evaluate the impact of this system on physician awareness of test results finalized after discharge.

Hypothesis: Automatic email notification will improve physician awareness of test results finalized after discharge compared to usual care.

Specific Aims: (Study #2, funded by CRICO, completed July 2012)

1. To identify a cohort of discharged patients with potentially actionable results of tests pending at discharge (TPAD).
2. To determine if automated email notification of the finalized results of potentially actionable TPADs affects the rate of post-discharge actions taken as documented in the electronic medical record (EMR).

Hypothesis: Automated email notification of the finalized results of potentially actionable TPADs increases the rate of actions taken post-discharge.

Failure to follow up on abnormal test results is a critical problem and is more likely to occur in the case of tests that are performed in the hospital but whose results are not available or not finalized until after discharge (i.e., pending test results). Responsible inpatient and ambulatory providers may not be aware of these test results. In a prior study, Roy et al. determined that 41% of patients were discharged before all laboratory, microbiology, and radiology test results were finalized (31% were collectively hematology, chemistry, and pathology tests, 27% were radiology studies, and 42% were microbiology results). Of these results, 9.4% were considered potentially actionable by independent physician review and could have altered the post-discharge patient care plan. Physicians were only aware of 38% of these test results. Failure to follow-up on these test results can lead to delays in diagnosis, missed treatment opportunities, redundant ordering of tests, and subsequent patient harm. In a hospital the size of Brigham and Women's Hospital (BWH) with 44,000 annual admissions, physicians would be unaware of almost 2000 actionable test results per year. Automated systems can mitigate this problem by ensuring prompt notification of relevant test results finalized after discharge to responsible inpatient and ambulatory providers. Using internal BWH funding, we have developed an automated email notification system to facilitate management of tests pending at discharge (TPADs).

In study 1 (funded by AHRQ), we will prospectively evaluate the impact of this intervention on physician awareness of TPAD results. In study 2 (funded by CRICO), we will perform a chart review to determine the impact of the intervention on downstream actions taken by physicians and acknowledgment of TPAD results as documented in the electronic medical record.

Inclusion Criteria:

• Any patient discharged from selected services at BWH whose inpatient attending and primary care provider are in the same arm of the study.

Exclusion Criteria:

• Any patient discharged from selected services at BWH whose inpatient attending and primary care provider are in discordant arms of the study.